Have Your Cake And Eat It Too - Module 2 PDF

Have Your Cake and Eat It, Too By Norman Dennis E. Marquez, MD, Lua M. Pottier, and Genejane M. Adarlo, MD, PhD Health Sciences Program, Ateneo de Manila University The cosmopolitan diet encourages us to indulge, but to keep it close to zero calorie… a sophistication that is like having cake but no...

Have Your Cake and Eat It, Too By Norman Dennis E. Marquez, MD, Lua M. Pottier, and Genejane M. Adarlo, MD, PhD Health Sciences Program, Ateneo de Manila University The cosmopolitan diet encourages us to indulge, but to keep it close to zero calorie… a sophistication that is like having cake but not being allowed to eat it. It sounds masochistic. The tingling sensation that creeps along the veins1 leading to the brain with every bite of that succulent roast duck, or a crunch of that favorite pork rind makes one oblivious of the resolution to abstain at the next lechon party. The temptation of an extra serving of decadent chocolate cake challenges chocoholics who always try to “detoxify” themselves. The struggle between gustatory bliss and healthy eating remains, at times, a cognitive dilemma. When choosing where to go for gastronomic adventures or what comfort food to share with bosom buddies, the psychosocial values of food and eating may override the value of scientific data. In case one is unaware, food is part of our identity and social practice. It explains why eating is pleasurable and how our choices of food are linked to health issues. The study of nutrition, then, covers discussion on biochemical processes to public health perspective. It examines, as well, the impact of globalization on the food industry and identifies the factors to consider when making decisions for nutritious food, healthy lifestyle, and better quality of life. We are what we eat Food is central to our sense of identity (Caplan, 2013). Particularly, our choices of food form an important part of the identities of both individuals and social networks. As Fine observes, “the connection between identity and consumption gives food a central role in the creation of community, and we use our diet to convey images of public identity” (1996, p. 1). Food preference, for example, can stand for national, regional, linguistic, and religious variations. It can also represent differences in gender as consuming meat is related to masculinity, whereas eating vegetables is associated with femininity (Caplan, 2013). Additionally, food can symbolize class and status since those from upper class use food to differentiate themselves from the lower class (Bourdieu, 1989). We just have to observe the convergences at the buffet table to understand how food, or the sight of food, reveals what we value and who we share those values with. The revelations are fascinating seeing that “eating patterns,” as Delormier, Frohlich, and Potvin point out, “are understood to reflect systems of meaning constructed by people” (2009, p. 217). Once the signal to the open buffet is clear, guests rush or stroll to the table. Seasoned banqueters position themselves strategically close to their target cuisine. Those who take time at the salad bar are likely to hover around the dessert table before surveying the main course. Those who discriminately choose white over red meat, grilled over fried dish, or tomato-based over cream- based pasta sauces more obsessively count calories. While some do not seem to care what they put on their plates, others take time to ask how each of the dishes is prepared. Still, some cannot make up their minds and stall the line of the adventurous eaters and the favorites-only pickers. Those preparing feasts nowadays almost instinctively exercise a lot of sensitivity to their guests’ preferences, whether they are health concerns 1 More accurately, nerve fibers carry sensory stimuli, not veins. Also, arteries bring blood, with all its component nutrients, dissolved gases, and other substances, to the brain, while veins send it back to the central circulatory system. Page 1 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University. or personal beliefs. In relative scientific, religious, or political tones, the menu reflects the personae of what we eat or do not eat. Eating is fun The satisfaction of a hearty meal must have inspired the “Happy Meal” concept of McDonald’s and the “Langhap Sarap”2 campaign of Jollibee. The image of a child surrounded by friends and enjoying a party associates the food to a happy moment, prompting parents to bring their child to the food outlet whenever the child feels down. The convenience of drive-thru facilities makes the treat even easier. With delivery hotline numbers and internet gateways, children can get a quick fix of their favorite burger or pizza, even when their parents are too busy to drive to the nearest franchise. The alternative, of course, is the instant noodle mix that is fun to prepare as well. Families and friends can share a meal in a jiffy, like magic… full of illusions. The truth is, eating is a celebration at its best when shared with someone going through a similar experience. Such joyous feasting is very evident when Christian families share the noche Buena (the meal after Christmas midnight Mass) on Christmas Eve or when Muslims celebrate Eid al-Fitr at the end of Ramadan (a three-day celebration to break the month-long fast). Food itself is pleasurable but fundamentally, food provides energy that allows bodily functions. Components of food undergo biochemical changes in the body that are associated not only with energy but also with other physiologic processes. For instance, the study of Fernstrom (2000) affirms that coffee, tea, and chocolates contain caffeine that raises alertness. This particular boost makes one go through work and recreational activities with a little more gusto. In the same paper, he points to a one-carbon metabolic pathway as the probable mechanism for folate to facilitate mood reactions, suggesting its use as a supplement in anti-depressant therapy. Still, with the extreme pleasure of a sumptuous meal, comes a calming satisfaction of wanting to retire after a binge. As suggested by Burdakov, Gerasimenko, and Verkhratsky (2005), glucose levels increase or decrease wakefulness within bounds of what the brain can take. Too much glucose influences the brain to instruct the body to conserve the energy recently accumulated after a heavy meal, making one sleepy. Furthermore, the absorption of glucose is regulated by hormones (US National Library of Medicine, 2018). It goes through a series of metabolic transformations to produce energy. This energy will either be used or stored depending on a physiologic or behavioral need. Hence, likening “sugar rush” to “adrenaline rush” is misleading, especially if viewed as the cause of children or adults to bounce up and down after a heavy meal. The presence of energy itself does not result in a muscle movement in the same way that a bullet does not fire a gun. Eating and health The pleasure of eating, however, does not happen without consequence. The proliferation of fast food chains and myriads of instant food products have been associated with increased health problems, initially in Western society. These food products contain high energy density with high fat and salt content that do not provide equivalent satiety, thus leading to passive overconsumption (Alder, Abraham, van Teijlingen, & Porter, 2009). Coupled with sedentary lifestyle, this overindulgence leads to obesity. It is not difficult to understand that the less energy spent in activities, the more energy is stored in the body. The excess sugars and proteins, not just fats, that the body absorbs, are then converted to fats (see Figure 1). Salt, specifically high sodium level, has long been associated with elevated blood pressure (Chobanian & Hill, 2000). 2 A Filipino phrase coined to mean “smell-savor the delicious taste” Page 2 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University.  Carbohydrates: starch and sugars Lipids: fats and oils pyruvate Acetyl-CoA Proteins: amino acids Figure 1. Convergence of the metabolic pathways of energy molecules; excess energy from food are converted to fat tissues. Aiming for an attractive physique or well-sculpted abdominal muscles is incongruent to this eating behavior. Each generation portrays the desirable body shape and size and there is the urge to conform to it. Teenage groups are particularly pressured to subscribe to this standard body frame in order to fit in. But the reactive under-eating also leads to detrimental effects, ranging from a specific nutrient deficiency to a whole lot of nutritional disorders. The longer time one gets from the real to the ideal, the greater the dissatisfaction; this leads to poor self-image and even to depression (Sadock, Sadock, & Ruiz, 2017). The ideal body shape seems to be an impossible dream with unbeatable foes in culinary delights around. The quixotic challenge, thus, is to commit to healthy food choices along with a lifelong exercise program (Alder et al., 2009). Food and nutrition The foundations of nutrition science were laid by Antoine Lavoisier when he designed a special calorimeter in the early 1780s to estimate metabolic heat (Stafford, 2010). However, the earliest dietary recommendations were published by the US Department of Agriculture (USDA) in 1894 in the form of a Farmer’s Bulletin and the first edition of Nutrition and Your Health: Dietary Guidelines for Americans was published in 1980 by the USDA and US Department of Health and Human Services (Davis & Saltos, 1999). Scientific explorations in the last two hundred years have revealed a great deal appreciation of how substances in food affect the well-being of humans. Like the teenage years riddled with many issues and challenges, research in nutrition, not infrequently, shows complex relationships and even conflicting results. Viewed cynically, the science of nutrition seems to change depending on what is being studied and who is funding those studies; but viewed positively, it is a dynamic field that is constantly evolving as the understanding of food and the relationships of its component parts deepens. For instance, iron has been Page 3 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University. considered as an essential nutrient3 and plays a significant role in the formation of hemoglobin, the major protein that transports oxygen in the blood (Koepen & Stanton, 2017). However, excessive oral intake of iron may limit the absorption of zinc, which is another important nutrient in growth and development (Sandström, Davidsson, Cederblad, & Lönnerdal, 1985). Furthermore, iron found in animal products is more readily absorbed by humans than iron ingested from plant sources (Layrisse et al., 1969). Findings such as these have prompted the science of nutrition to expand from qualitative to quantitative research. Practical experience and the pursuit of knowledge have guided research in nutrition to take multiple directions. The idea that food allows living things to grow and that cells do not transform into the cells they consume point to fundamental components of food that are essential to life. With advances in chemistry and biology, scientists have identified essential organic and inorganic substances and their specific roles in cellular processes. Of much interest to researchers – and what science is only beginning to clarify in the last few decades – is that different species require different types of nutrients to be available at different amounts in specific stages of development. Even in the same species, there seems to be an optimally relative concentration difference among these nutrients that gives maximum benefit. Children need less zinc per day compared to adolescents and adults (National Institutes of Health, 2016). Also, women demand higher amounts of folate during pregnancy than in non-pregnant state (National Institutes of Health, 2016). The modern diet has to provide now measurements of Recommended Daily Allowance (RDA) and to consider Body Mass Index (BMI), among others. The health-conscious individual is bound to choose a diet plan that is both effective and realistic. Here lies the problem. Diet protocols, such as the Atkins diet and the Mayo Clinic diet and their modifications that help manage weight problems as well as metabolic disorders, have been equally validated by research (Anton et al., 2017; Zelman, 2016). Still, food faddism and consumerism have diluted the recommendations supported by scientific evidence. While vegetarians are associated with healthier lifestyles, vegans – those who consume only plant products, as differentiated from “lacto-ovo vegetarians” who include eggs and dairy products – are constantly challenged to consume a variety of fruits and vegetables to obtain the essential amino acids that are limited in plant products. Debates on the superiority of organic food over agricultural products that use synthetic fertilizers and pesticides are marred by political and cultural tones, even when there is no conclusive evidence yet that they are more nutritious or safer (Smith-Spangler et al., 2012). The Economist in its September 2010 article entitled “Yuck: Making Healthy Food is Easy, Making People Eat It is Not” reported that more than ninety percent of Americans believe that they must eat healthily; yet, they shift from low fat to low carbohydrate to high fiber diets peppered with probiotics 4 as well as other dietary supplements, depending on what is available in the market. More daunting, pseudo- science, frank quackery, and fraud continue to challenge research data through strong cultures, or counter- cultures, and unresponsive, if not, oppressive, politics. Nutrition and public health However, nutrition science is not only confined to individual concerns for well-being. Aside from addressing the specific dietary needs of individuals, it also focuses on issues affecting the population (Hughes, 2003). It includes the study of “interactions within and between all relevant biological, social, and 3 A nutrient is a chemical substance, usually in food, necessary in metabolic processes responsible for growth and repair of cells and tissues 4 Probiotics are mostly live bacteria that are similar to beneficial microorganisms formally found in the intestines (National Center for Complementary and Integrative Health, 2017) Page 4 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University. environmental systems” and forms the “basis for food and nutrition policies” (Beauman et al., 2005, p. 697). Research and practice in nutrition has thereby expanded from the identification of essential nutrients and the recommended intake levels to the maximization of benefits from these nutrients and other food components, such as fibers and carotenoids5, as well as the effective communication of health information to guide healthy living of the population. This has become more necessary as the 2009 report of the World Health Organization showed that the five leading global risks for mortality are high blood pressure, tobacco use, high blood glucose, physical inactivity, and overweight and obesity. More specifically, such necessity stems from an increase in risk factors for non-communicable diseases (i.e. cardiovascular diseases, diabetes, and certain types of cancer) that are brought by individual lifestyles, which in turn, are influenced by policy and economic forces on a societal level. Unsurprisingly, food choices are increasingly being called on to act as tools for social change given that food integrates the world and allows us to see the social consequences of private actions. These choices remind us of our moral responsibilities even as we engage in a private and physiological act (Belasco, 2005). Still, food has also developed from a basic component of life into a main expression of culture and family values on the individual level and a multi-billion-dollar international business interest on the societal level. Challenges with the global food industry Before agriculture developed into an industry, food came straight from the relevant plant or animal source to the less discriminate palate of early nomads. From the time men settled in communities and the demand for food increased with the population, the gathering and preparing of food has become more elaborate and complex. As nations share culture and develop import-export industries and demand for exotic delicacies, the food that lands on dinner plates has often covered more geographical distances than many can hope for in their lifetimes. The tuna trade, representing the globalization of the Japanese sashimi, for instance, is a local/regional industry with centuries-old practices and distinct culinary culture that, now, must deal with international competition and technology in the face of problematic environmental regulations and complex market behavior affecting labor practices and investment plans (Bestor, 2005). While this reflects the impact of globalization on the food industry, it tends to leave related questions as to food safety, quality, packaging, processing, additives, and ultimate nutritional content at time of consumption. The answers can be described, at best, as works in progress. This challenge is further reflected in an article by Narayan, Ali, and Koplan (2010) in which they explore the paradox between supporting economic growth on a global scale (which brings about improvements in health and advances in technology) and the dark side of globalization (which leads to an increase in global poverty and a widening gap between rich and poor). The authors connect these realities to the increase in non-communicable diseases by stating that the “current political and economic incentives favor industry and other interest groups at the expense of health: consider the subsidies paid for corn-based agriculture and mass-produced processed foods, the tobacco revenue generated in countries with a government-owned tobacco industry, industrial growth in the face of environmental pollution, and the spread of the sedentary automobile-and-television culture” (Narayan et al., 2010, p. 1196-1197). The Economist (2010) yet identified another challenge currently facing the food industry, and that is the disparity between stated consumer demand and actual consumer purchases. While more consumers are saying that they expect “healthier” food products, market sales do not seem to reflect a true understanding 5These are yellow, orange, and red pigments produced by plants epidemiology linked to decreased risks in cardiovascular diseases and some cancers (Delage, 2016). Page 5 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University. of what their request entails. People want to be healthy. However, rather than substantially changing lifestyles, their preference is for the food industry to find ways to incorporate “health” and convenience into food products that they like and have become accustomed to eating. For example, American eating habits has shifted from foods that must be prepared (i.e. pot roasts and peas) to those that are convenient (i.e. pizzas and frozen sandwiches). Taste, value, and convenience are most important to consumers, while healthy and nutritious are only secondary considerations. While this refers to Americans, it could just easily apply to other populations. In the Philippine context, perhaps, one indication of this behavior is Jollibee Food Corporation’s net income of 6.714 billion pesos in 2017, a 10.9% increase from sales in 2016 (GMA Network, 2018). Its rival, McDonald’s Philippines also projected a double-digit growth in revenue for 2017 when it posted a 70% increase in net profit during 2016 (Sunstar, 2017; GMA Network, 2017). Similarly, the sales of pizza chain, Shakey’s Philippines, increased by 15% in 2017 despite tight competition for consumers (Rappler, 2017). Food and decision-making model Choosing what to eat and planning how to live have thus become even more challenging. By extension, the degree to which these decisions impact public health and related social issues makes the exercise more complex. One may consider four pillars (see Figure 2) when making such decisions (Edelstein, 2017). System structures and relevant policies and regulations Food availability and Decision and accessibility; purchasing Research power Choice Individual/Family nutritional needs Figure 2. The four pillars of decision-making, which draw its inspiration from the concept presented in “The Relationship Among Nutrition Research, Legislation, Stakeholders, and Nutrition Programs and Policies” by O’Neil and Nicklas (2011). Research. There is a range of studies describing nutrients and healthy preparation of food. Recently, research in nutrition includes applications in the social sciences beyond the understanding of biochemical and physiological processes. One interesting find that benefitted from the multi-disciplinary and inter- Page 6 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University. disciplinary approaches to health and nutrition demonstrates the relationship of obesity and physical activity. Specifically, the study of Cleland, Schmidt, Dwyer, and Venn (2008) suggests that young adults, who watch more than three hours of television, are more likely to be obese partially because of the increased consumption of food and beverage while watching television. The same study indicates that over decrease in leisure-time physical activity with watching television does not establish the causation, and that other behavior may contribute to the relationship. Furthermore, previous studies suggest that eating a late dinner of large mixed meals may be associated with unfavorable changes in weight management and risk for diabetes (Kinsey & Ormsbee, 2015). This sends a valuable message on how lifestyle can impact individual and public health. As starting point, scientific data can provide specific directions to the process of decision- making. Structures and policies. Decisions are not made in a vacuum. The reality is that individuals and societies move within the confines of political, economic, and socio-cultural systems. These systems operate on policies and laws that reflect the people’s beliefs and values. Responsive and just systems allow individuals to choose freely. When laws prevent agriculture and food technology to develop safe and functional food because of the interest of personal belief, the rest of the population will be deprived of potential cost-effective benefits. Regulations on growing, packaging, and manufacturing of food should ensure the safety and completeness of the final products as they make their way to consumers. At the same time, they should address the challenges of waste disposal and promote environmental health as well. Advertising and promotion are expected to be truthful and validated. It is easier to choose to be healthy when structures and policies support and promote healthy choices and abhors unhealthy practices from the production to storage to transport to distribution to disposal, and even recycling of food. Availability and accessibility. Laws are only meaningful if they are implemented properly and consistently. Systems are deemed effective and productive when they provide services that are congruent to their values. Nutrition programs work well when healthy food choices are readily available. If healthy choices are outnumbered by unhealthy choices, the message could be lost. A trip to the nearest supermarket may prove how children can be taught, or misinformed, as they choose from the products found on the grocery shelves. For one, the “healthy food” section should be sought out specifically. Second, some grocery stores, and most convenience stores, do not offer such healthy food items; if they do, the price range in this section is generally higher than the more available products. Third, food labels, at least in the Philippines, have not been standardized. Information on the nutrient values and full contents of food products sold in the market are important to make decisions that impact health. The ubiquitous disclaimer “no approved therapeutic claim” found in many food products confuses and misleads the unsuspecting consumer. As with food, time for exercise and adequate rest must be available to the health conscious. Institutions that promote wellness and provide real time and resources to employees as part of their work details are amiable. Companies and work stations that are poorly lit, poorly ventilated, and cramped are unhealthy and unfit for creative and productive work. Individual need and choice. Individuals are first responsible for themselves, then influential in their family and community settings. For many, food is either something that appears magically on the dinner table or it is something to feel guilty about after an indulgence. With the enlightenment of research, the enabling (or restricting) system, and the availability and accessibility of real choices, one is cautioned not to take an extreme view regarding food and health. One must be critical and vigilant to inform one’s conscious decision. One must also create and support a setting of free choice, not a menu of self-harm and environmental destruction. A more discriminating and prudent attitude towards the modern diet should be moderation and balance, coupled with adequate physical activity and spiritual exercises. A substantive serving of food (processed, unprocessed, organic, meat, or vegetable) will serve one’s basic needs of providing the body with fuel to keep going until the next meal. A long-term commitment to healthy choices requires some finesse in planning overall food trend to meet lifestyle and quality of life goals. Page 7 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University. Your choice Reality sets in when you are to make an actual decision, with fear of the knowledge of how much and when to eat will most likely lead to misery and failure. Similarly, the depth of your pocket and how far you can stretch your resources to achieve the quality of life you are hoping for narrow down your choices. Some can afford to buy fresh vegetables and fresh meat with a big tub of ice cream. Others only have the choice of processed hot dog and instant noodle mix. You seem in a better position when the problem is how to include at least a few items that promote health into your budget and spending. More importantly, the real choice involves being honest with yourself regarding your motivation to be healthy and committing to a lifestyle that is not simply to please others. You probably have heard the saying, “when there is a will, there is a way.” By applying conscious decision-making in what to buy and how much to eat based on a realistic assessment of resources, goals, and activity levels, it becomes possible to have your cake and eat it, too. Page 8 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University. References Alder, B., Abraham, C., van Teijlingen, E., & Porter, M. (2009). Psychology and Sociology Applied Medicine. Amsterdam, NL: Elsevier Health Sciences. 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Retrieved from https://www.webmd.com/diet/features/the-mayo-clinic-diet#2 Page 10 of 10 Version August 2018 © 2018 - Ateneo de Manila University. All rights reserved. This is solely for the use of students of Sci10 (Science and Society) SY 2018-2019 and is the property of the Ateneo de Manila University and may not be reproduced or sold without the written permission of the University.